Factors associated with the involvement of lymph nodes in low-grade serous ovarian cancer

Role of lymphadenectomy for apparent early-stage low-grade serous ovarian carcinoma

OBJECTIVE

Investigate the prevalence of lymph node metastasis and impact of lymphadenectomy on the survival of patients with apparent early-stage low-grade serous ovarian carcinoma.

METHODS

Patients with apparent early-stage low-grade serous ovarian carcinoma diagnosed between 2004 and 2015 were identified in the National Cancer Database. The performance of lymphadenectomy and incidence of lymph node metastasis were assessed from pathology report. Overall survival was compared with the log-rank test, and a Cox model was constructed to control for a priori selected confounders.

RESULTS

A total of 977 patients were identified. The rate of lymphadenectomy was 65.9%, whereas the median number of lymph nodes removed was 12. There were no differences between patients who did and did not undergo lymphadenectomy in terms of patient age, race, insurance status, apparent disease stage, and type of treatment facility. The rate of adjuvant chemotherapy use was higher in patients who underwent lymphadenectomy (33.5% vs 26.4%, p = .024). The overall incidence of lymphadenectomy metastasis was 7.5%, which was higher in patients with stage IC (10.1%) than in those with stage IA disease (5.6%), p = .031. Patients who underwent lymphadenectomy had better overall survival than those who had did not, p < .001; the 5-year overall survival rates were 91.6% and 83.3%, respectively. After controlling for confounders, performance of lymphadenectomy was associated with better overall survival (HR 0.67, 95% CI 0.48-0.93).

CONCLUSIONS

The incidence of lymph node metastases among apparent early-stage low-grade serous ovarian carcinoma is not negligible, especially in patients with apparent stage IC disease. Performance of lymphadenectomy may be associated with a survival benefit likely secondary to stage migration.

Characterizing Lymphovascular Invasion in Pediatric and Adolescent Malignant Ovarian Nongerminomatous Germ Cell Tumors: A Report from the Children's Oncology Group

BACKGROUND

Lymphovascular invasion (LVI) has been identified as a poor prognostic factor for a variety of tumors; however, its significance in malignant ovarian germ cell tumors (MOGCT) in pediatric and adolescent patients is not well described. We aim to clarify the significance of LVI in the subset of patients with nongerminomatous MOGCT.

METHODS

Records of patients 0-20 years of age with MOGCT enrolled on Children's Oncology Group study AGCT0132 were reviewed. Patients with documented presence or absence of LVI in either institutional or central review pathology reports were included.

RESULTS

Of 130 patients with MOGCTs, 83 patients had of the presence or absence of LVI documented in their pathology report. 42/83 patients (50.6%) were found to have LVI present. The estimated odds of having LVI was higher in patients with stage II and III disease, 11 years and older and with the presence of choriocarcinoma. Event-free survival (EFS) and overall survival (OS) remained high in patients with LVI. Approximately 50% of patients with a documented LVI status in either institutional pathology report or central review were found to have LVI.

CONCLUSIONS

The presence of LVI was higher in tumors with adverse risk factors including higher stage and age greater than 11 years. While LVI was not associated with EFS or OS in the intermediate risk group, further work is necessary to determine the effect of LVI on long-term disease-free survival. We, therefore, recommend routinely incorporating LVI status into institutional pathology reports for pediatric and adolescent patients with MOGCT.

LEVEL OF EVIDENCE

III.

Lymphatic vasculature in ovarian cancer

Ovarian cancer (OVCA) is the second most common gynecological cancer and one of the leading causes of cancer related mortality among women. Recent studies suggest that among ovarian cancer patients at least 70% of the cases experience the involvement of lymph nodes and metastases through lymphatic vascular network. However, the impact of lymphatic system in the growth, spread and the evolution of ovarian cancer, its contribution towards the landscape of ovarian tissue resident immune cells and their metabolic responses is still a major knowledge gap. In this review first we present the epidemiological aspect of the OVCA, the lymphatic architecture of the ovary, we discuss the role of lymphatic circulation in regulation of ovarian tumor microenvironment, metabolic basis of the upregulation of lymphangiogenesis which is often observed during progression of ovarian metastasis and ascites development. Further we describe the implication of several mediators which influence both lymphatic vasculature as well as ovarian tumor microenvironment and conclude with several therapeutic strategies for targeting lymphatic vasculature in ovarian cancer progression in present day.

Incidence of lymph node metastasis in early-stage low-grade serous ovarian cancer: a systematic review

OBJECTIVE

The objective of this systematic review was to assess the incidence of lymph node metastasis in patients with clinically presumed early-stage low-grade serous ovarian cancer that underwent primary surgical treatment.

METHODS

This study was registered in PROSPERO (CRD42022308923). A systematic literature review was conducted following the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) checklist. PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Ovid, and Scopus databases were searched since inception and up to March 2022. The inclusion criteria were: pathological confirmation of low-grade serous ovarian cancer (clinically presumed FIGO 2014 stages I-IIA at time of surgery) that underwent primary surgical treatment, including pelvic and/or para-aortic lymph node dissection.

RESULTS

The search identified 3763 articles; 59 were considered potentially eligible after removing duplicates, and eight studies finally met the selection criteria. In total, 35 of 277 (12.6%) patients had lymph node metastasis, and only four studies reported upstaging due to lymph node metastasis in 16 of 153 (10.5%) patients. None of the eight studies included reported the rate of complications or complications specifically for the subgroup of patients with early-stage low-grade tumors.

CONCLUSION

In patients with early-stage low-grade serous ovarian cancer, lymph node assessment should be discussed when counseling for primary surgical staging.